The impact of anaemia and intravenous iron replacement therapy on outcomes in cardiac surgery

Abstract

Anaemia is common in patients with cardiac disease and also in those undergoing cardiac surgery. There is increasing evidence that preoperative anaemia is associated with increased patient morbidity and mortality following surgery. We performed a systematic literature review to assess the impact of anaemia and intravenous (IV) iron supplementation on outcomes in cardiac surgery. Sixteen studies examined preoperative anaemia in detail. One study examined the role of preoperative IV iron administration and a further three, the effect of postoperative iron supplementation on haemoglobin (Hb) levels and the need for transfusion. Preoperative anaemia was associated with higher mortality, more postoperative blood transfusions, longer intensive care unit (ICU) and total hospital stay and also a greater incidence of postoperative cardiovascular events. In the single study that examined preoperative IV iron in combination with erythropoietin treatment, there was decreased blood transfusion, shorter hospital stay and an increase in patient survival. However, this was a small retrospective cohort study, with the observation and treatment groups analysed over different time periods. Postoperative administration of IV iron therapy, either alone or in combination with erythropoietin, was not effective in raising Hb levels or reducing red cell concentrate transfusion. On the basis of currently available evidence, the effect of perioperative administration of IV iron to cardiac surgery patients, alone or in combination with erythropoietin, remains unproven. Well-designed and appropriately powered prospective randomized controlled trials are needed to evaluate perioperative iron supplementation in the context of cardiac surgery.

Blood conservation in cardiac surgery

“…In their systematic review, Hogan et al . () could not find any evidence of improved outcomes associated with post‐operative iron supplementation. A recent multicentre RCT investigated the use of post‐operative IV ferric carboxymaltose (vs placebo) in 201 non‐cardiac surgical anaemic patients (Khalafallah et al, ).…”

“…Hogan et al . () systematically reviewed the available evidence and retrieved 16 articles investigating the role of pre‐operative anaemia in cardiac surgery, of which only 4 articles (1 interventional cohort study and 3 randomised controlled trials [RCTs]) explored the effect of perioperative intravenous iron administration. High‐quality evidence of improved outcomes when iron supplementation is used in cardiac surgery could not be found.…”

Blood transfusion practice in a referral cardiovascular center in tehran, iran: A critical point of view

“…We have not any pre-donation protocol in our center. Preoperative visit with surgeon or anesthesiologist (16) can detect and correct preoperative anemia with iron tablets (17) or erythropoietin (18). Also we didn’t use an acute normo-volumic dilution (ANH) technique during operation.…”

Patient-oriented blood-saving concept in operations with cardiopulmonary bypass

“…В целом от-мечается «неправильный» (отличный от истинного) рас-чет Ht у 18-21% пациентов, подвергающихся вмешатель-ствам в условиях ИК [23]. Другие методы снижения уров-ня гемодилюции многими авторами считаются достаточ-ными: коррекция анемии до операции [24]; использова-ние тренд-положения, вазопрессоров и коллоидов на вводном наркозе [25]; хирургические методы снижения кровопотери, включая реинфузию сепарированных эри-троцитов; минимизация объема контура ИК или (по огра-ниченным показаниям) использование MiECC-систем [26,27]; применение кровяной кардиоплегии [28], пре-вентивное использование донорских эритроцитов только при реоперациях [29].…”